P5.030 New Avenues For Proactive HIV Testing in Primary Care Required: A Trend Analysis of Twenty Years of HIV-Related Consultations in Dutch General Practise

Abstract

Background: In the Netherlands 30-40% of HIV-infected persons are not aware of their status. Half of the newly diagnosed present late. Late treatment reduces life expectancy with approximately 10 years. Early treatment reduces transmission to sex partners with 96%. A more proactive role in testing in primary care is advocated. In the Netherlands the GP is the main care provider, also for sexual health. We investigated the trend in HIV-related consultations and testing practises in general practise in the last 2 decades. Methods: Within a nationally representative Dutch Sentinel General Practice Network we analysed HIV-related consultations from 1988-2009 using a questionnaire, in which patient's characteristics, the reason for consulting the GP, interventions and test results were recorded. Trends over time were calculated by multilevel analysis. Results: Time trend analyses show an increasing trend in HIV-related consultations and in the total number of HIV tests per 10,000 registered patients. Mean number of consultations doubled from 7 in 1988 to 14 consultations/10.000 population in 2009. Over the whole period, the number of HIV-related consultations was significantly higher in urban areas. The proportion of people high at risk, men who have sex with men (MSM) decreased. The proportion of HIV related consultations initiated by the GP increased from 11% in 1988 to 23% in 2009. Conclusion: In this 20-year period the policies around HIV testing changed drastically. HIV-related consultations, as well as provider initiated testing in general practise in the Netherlands increased, however slowly and mainly in low risk groups. Testing rates remain low. To prevent undiagnosed and late presentation of HIV infection, GP need to be more pro-active. New and innovative avenues, like opt-out and indicator-based testing, are needed in primary care as many test-opportunities among high risk groups and in high risk areas are missed.